PUPU ORI (Tahitian School): (What is the name of your Halau, Group or Organization?)

CONTESTANT INFORMATION

*Elite Contestants must meet the "Elite Criteria": Must have placed 1st, 2nd or 3rd Place in any Ori Tahitian Competition.

CONTESTANT 1 Full Name
*

First Name Last Name

Birthday
*

-
Month
-
Day Year

PARENT OR LEGAL GUARDIAN OF MINOR UNDER AGE 18 NAMED ABOVE.

The Person named above assumes full responsibility of the Minor Contestant named above, and hereby gives said Minor permission to compete in the ITO Competition.

Address
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number
*

-
Area Code Phone Number

E-mail
*

CONTESTANT 2 Full Name

First Name Last Name

Birthday

-
Month
-
Day Year

PARENT OR LEGAL GUARDIAN OF MINOR UNDER AGE 18 NAMED ABOVE.

The Person named above assumes full responsibility of the Minor Contestant named above, and hereby gives said Minor permission to compete in the ITO Competition.

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number

-
Area Code Phone Number

E-mail

CONTESTANT 3 Full Name

First Name Last Name

Birthday

-
Month
-
Day Year

PARENT OR LEGAL GUARDIAN OF MINOR UNDER AGE 18 NAMED ABOVE.

The Person named above assumes full responsibility of the Minor Contestant named above, and hereby gives said Minor permission to compete in the ITO Competition.

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number

-
Area Code Phone Number

E-mail

CONTESTANT 4 Full Name

First Name Last Name

Birthday

-
Month
-
Day Year

PARENT OR LEGAL GUARDIAN OF MINOR UNDER AGE 18 NAMED ABOVE.

The Person named above assumes full responsibility of the Minor Contestant named above, and hereby gives said Minor permission to compete in the ITO Competition.

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number

-
Area Code Phone Number

E-mail

CONTESTANT 5 Full Name

First Name Last Name

Birthday

-
Month
-
Day Year

PARENT OR LEGAL GUARDIAN OF MINOR UNDER AGE 18 NAMED ABOVE.

The Person named above assumes full responsibility of the Minor Contestant named above, and hereby gives said Minor permission to compete in the ITO Competition.

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number

-
Area Code Phone Number

E-mail

REGISTRATION CONFIRMATION & PAYMENT

CONFIRM ALL CONTESTANTS ON THIS FORM IS IN THE SAME DANCE, AGE & GENDER CATEGORY?
*

Type YES to Confirm. If NO, a New Registration Form must be submitted for each Specific Category.

Number of Dancers Registering

ITO DANCER Registration Fee payment through PayPal

ITO PRIME DANCER REGISTRATION
$
55.00

Quantity

ITO ELITE DANCER REGISTRATION
$
65.00

Quantity

HOLD HARMLESS AGREEMENT

A Hold Harmless Agreement is REQUIRED by each ParticipantIf this is a Multiple Entry Registration a signed hard copy is required by each Participant listed above.Click & Print > Hold Harmless Agreement Form

Each participant, parent and/or guardians of participants under the age of 18, and/or organization shall hold harmless and indemnify, PACIFIC TALENT ACADEMY OF THE ARTS and its Board Members (collectively "PTAA"), volunteers, and the City of Long Beach California and Long Beach Recreation Park from every liability, claim or demand, which liability, claim or demand may be made by reason of:

Any injury to person(s) or property, sustained by any persons, firm or corporation caused by any act, negligence, default or omission of the participating organization or any person firm or corporation directly or indirectly engaged by or upon or in connection with the event, whether the injury or damage occurs at the Weekend in Polynesia events, Long Beach California, Long Beach Recreation Park, host hotels or any other related location.

The furnishing or use of any copyrighted composition; secret process patented or unpatented invasion, article or appliance during the event.

The participant(s), parent and/or guardians of participants under the age of 18, and/or organization(s) at its own cost, expense and risk shall defend all legal proceeding that may be brought against the committee, its board, its officers and volunteers on any such liability, claim or demand and satisfy a resulting judgment that may be rendered against any of them whether or not the liability, claim or demand was actually or allegedly caused wholly or in part through the negligence or other implying conduct of any of them.

The participant(s), parent and/or guardians of participants under the age of 18, and/or organization(s) agrees to allow PTAA to use their images or likeness for advertising purposes and allows PTAA to video tape their performance or presence at the event for their archives and use within the organization and website.

I Acknowledge and accept the terms as outlined in the Hold Harmless Agreement.

I acknowledge the requirements to submit a valid registration prior to the application submittal deadline. This includes the correct fee payment for the number of registrants on this form. I also understand that an invalid form will be rejected and may cause the application to revert to a walk in contestant if payment is not received by deadline. At least one contestant must be entered to submit form. Required fields are indicated by a red asterisk.
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